Megan McArdle over at The Atlantic is one of our favorite bloggers, as she routinely discusses various practical aspects of combining economics with human behavior. Megan has apparently committed herself to another project for the next few weeks or months, and has left her blog in the hands of several guest bloggers – a couple of whom often write about healthcare. Today two of them posted pieces that we found quite interesting, and we wanted you, our readers, to know about them.
The first of these two articles, entitled Need a Reason to Question Obamacare? Just Look to Louisiana is by Avik Roy, who usually does a great job blogging at The Apothecary blog over at Forbes. In this post, Mr. Roy talks about “The Louisiana Purchase” – the deal made with Sen. Mary Landrieu’s (D., La.) that was supposed to give her state $200 million in extra federal Medicaid Funds in exchange for her support for the Patient Protection and Affordable Care Act (“ObamaCare”). In one of those unaccountable mistakes that can only happen in the halls and back rooms of our nation’s capital, it seems that in the course of torturing the language of the bill so that only Louisiana would get this special deal, they accidentally awarded Ms. Landrieu’s constituents $4.3 billion due to “a drafting error”. From Mr. Roy’s post:
On March 20, 2010, hours before the final vote on the health care bill in the House of Representatives, the Congressional Budget Office and the Joint Committee on Taxation issued their fiscal scoring of the bill. According to their analysis, the “Louisiana Purchase” would cost $0.1 billion in 2011 and $0.1 billion in 2012, with no additional spending thereafter for a total of $0.2 billion, or approximately $200 million.
Republicans were angry, as were many voters. But while President Obama voiced some opposition to the special deals cut in Congress in support of his signature legislation, he made an exception for the Louisiana Medicaid adjustment, incorrectly asserting that the language also applied to Hawaii:
“Something that was called a special deal was for Louisiana. It was said that there were billions–millions of dollars going to Louisiana, this was a special deal. Well, in fact, that provision, which I think should remain in, said that if a state has been affected by a natural catastrophe, that has created a special health care emergency in that state, they should get help. Louisiana, obviously, went through Katrina, and they’re still trying to deal with the enormous challenges that were faced because of that…That also–I’m giving you an example of one that I consider important. It also affects Hawaii, which went through an earthquake. So that’s not just a Louisiana provision. That is a provision that affects every state that is going through a natural catastrophe.”However, in November 2011, when the Centers for Medicare and Medicaid Services (CMS) tried to make sense of the legislation, they came up with a much larger number: $4.3 billion. This was, in part, because the text of the law didn’t phase out the adjustment in two years, as originally intended, but rather increased the federal subsidy in out-years.
The language in Section 2006, wrote CMS, “results in increased, rather than phased down, financial assistance to [Louisiana] each year, and allows [the state] to continue to qualify for assistance after their underlying FMAP has stabilized. The resulting assistance will be higher than initially projected.”
You can say that again. In fiscal year 2012 alone, the federal government sent about $700 million in supplemental funds to Louisiana’s Medicaid program, with another $3.6 billion to be spent in fiscal years 2013-2015. In FY13, the law changed the feds’ share of Louisiana Medicaid spending from 61 percent to 72 percent: a billion-dollar adjustment for the Bayou State.
Take a few minutes to read the article. It reads like a how-to manual on destroying the U.S. healthcare system by drafting laws that are either wickedly clever in their deceit of the public, or sublimely incompetent in the drafting.
The second Megan’s-guest-blogger article we’d like to highlight is “You’re Fat and You Know It: Why Government Anti-Obesity Efforts Fail” by Katherine Mangu-Ward. It’s hard to swing a cat anymore without having some part of it’s anatomy strike a state or federally-funded study or public education program designed to tell members of the heftier segment of the public that, contrary to what they might have heard elsewhere, being obese is actually not that good for you!
One interesting question is what the purpose of these messages is other than to spend everyone’s tax dollars? Is there anyone who does not know that being obese is not so great for your health? As it turns out, no:
Fat people have a surprisingly accurate sense of the health costs of being fat, for example:
“Finkelstein et al. conducted a survey of 1,130 adults in the United States to test whether overweight and obese individuals believe they are at greater risk of obesity-related diseases and premature mortality. They found that obese and overweight adults forecast life expectancies that are 3.9 and 2.4 years, respectively, shorter than those of normal-weight adults….The authors concluded that mortality predictions generated from the survey were “reasonably close” to those generated from actual life tables for adults in the United States.”
Numerous studies have found that lack of information about a healthy diet or opportunities to eat well aren’t the problem either. Cramming calorie counts and other nutrition information down customer’s throats doesn’t do much to change food choices. A second Marlow paper, forthcoming in what I’m told is the respectable journal Applied Economics Letters, finds that living near fast food doesn’t cause weight gain. That finding is supported by another recent study in the Archives of Internal Medicine, which found that living near supermarkets doesn’t improve diets, and (with the possible exception of young, low-income men) living near fast food doesn’t make for a less healthy diet.
So if telling people about the problem over and over and over does nothing to solve it, why does the government keep spending money on this? Why do we do the same unsuccessful thing over and over again in healthcare? Are we stupid or something?
To quote Forest Gump’s mom, “stupid is as stupid does.”